Informed Consent: An Overview
Kathleen M. Roman, MS*
the concept of informed consent, and what the term means to patients as well as
dental professionals, is critical in contemporary dental care. As outlined below, informed consent should be
formalized in order to more effectively educate patients about their own care,
drive compliance with a suggested treatment plan, and provide important risk
Informed Consent as the Patient’s Right
Public policy and court
rulings have continuously affirmed that patients have the right to make
decisions about their healthcare. Each
patient is a full partner in his or her healthcare team and, as such, is
entitled to participate in discussions about planning and implementation of any
kind of proposed treatment or procedure.
At a minimum, the informed consent process includes:
- An update on the patient’s current health status,
including a diagnosis. This discussion ensures that the patient
receives the results of tests or exams and can ask questions and voice
- Review of treatment options. Patients
cannot make good treatment decisions unless they know their options. Too often, options are presented from the
perspective of the patient’s presumed financial standing without taking in to
account the patient’s preferences and values.
If a treatment option is within an acceptable standard of care, it
should be presented to the patient.
- Risks and benefits associated with each treatment
option. These vary depending on the proposed
treatment. If there are two acceptable
treatment options for a dental condition, then both of these options should be
discussed with the patient. Information
to be shared should include: a) the presumed benefits of each treatment; b) the
possible minor complications or risks that most commonly occur with each
procedure; c) the potentially significant but rare complications; d) the
variance in treatment plans, e.g., Option A may involve more visits and/or more
physical discomfort than Option B; d) ranges of cost for each option; e) the
risks associated with electing not to have any treatment at all--a process
known as informed refusal.
- Documentation of the responses to the patient’s
questions as well as documentation of the patient’s agreement to comply with a
specific treatment plan. Documentation of consent without incorporation
of the previous three steps may not comprise a valid agreement.
Informed Consent as the Doctor’s Duty
It is the dentist’s
non-delegable duty to obtain a patient’s consent. Only the dentist has sufficient knowledge of
the patient and his or her condition, to be able to advise the patient and
address any questions or concerns.
Research has shown that
patients who feel informed and empowered report greater satisfaction with their
healthcare outcomes. Therefore, it is to
the dentist’s distinct advantage to use the educational and partnering aspects
of informed consent to engage the patient.
This same research has also
shown that patients who have been warned about possible complications are less
likely to be surprised and distrustful if a known complication does occur. This retention of good will gives the dentist
the opportunity to continue to work with the patient to obtain a satisfactory
Documentation of informed
consent serves as a clinical reminder for the dental team but it has
significant liability reduction benefits as well. The existence of a written consent may remind
a patient of aspects of the treatment plan that he or she had forgotten. The existence of a valid consent will make it
more difficult for a dissatisfied patient to allege that he or she was the
victim of negligent care.
The use of a formalized
informed consent process provides many benefits to the dental team as well as
to the patient. It can help the patient
be a better-informed and more proactive partner in his or her own care. It can reinforce each partner’s commitment to
the treatment plan. It can help identify
areas of misunderstanding or non-compliance and serve as a framework for
keeping the treatment plan on track.
Finally, it can verify the professional care and concern implemented by
the dentist on the patient’s behalf--a significant risk management benefit if
the patient is ultimately dissatisfied with the dental care provided.*Ms.
Roman is Risk Management Education Leader, Medical Protective, Indianapolis,
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